I-Team In-Depth – Connecticut Health Investigative Teamhttp://c-hit.org
In-depth Journalism on Issues of Health and SafetyMon, 13 Aug 2018 14:17:30 +0000en-UShourly1https://wordpress.org/?v=4.9.8Strategic Outreach Bridging Racial Gap In Pregnancy-Related Health Outcomeshttp://c-hit.org/2018/08/07/strategic-outreach-bridging-racial-gap-in-pregnancy-related-health-outcomes/
http://c-hit.org/2018/08/07/strategic-outreach-bridging-racial-gap-in-pregnancy-related-health-outcomes/#respondWed, 08 Aug 2018 01:02:54 +0000http://c-hit.org/?p=295143New Haven resident Kimberly Streater was pregnant with her third of six children when she called her friend for a ride to the hospital after sustaining a hit to her stomach by her then-husband.

When she reached the hospital, Streater, not yet 28 weeks pregnant, alerted personnel that her baby was coming—now. “They said, ‘No, no, he’s not coming,’ after I told them he was,” she recalled. Minutes later, Howie was born at 3 pounds and 1.5 ounces in the admitting area of the hospital, just as Streater had predicted.

Statistically, the preterm birth of Streater’s baby does not come as a surprise. In Connecticut and nationwide, black women and their infants suffer disproportionately worse pregnancy-related health outcomes than white women.

Carl Jordan Castro Photo

Kimberly Streater with her son Howard Lewis, 18, in her office in New Haven.

The March of Dimes’ 2017 Premature Birth Report Card for Connecticut revealed that between 2013 and 2015, 8.4 percent of all (live birth) infants born to white women were premature, compared with 12.4 percent of infants born to black women. Statewide, after a complication-free delivery, black women are twice as likely as white women to be readmitted to a hospital within 30 days, according to a 2015 study published in the journal Obstetrics and Gynecology, which drew from statistics maintained by the Connecticut Department of Public Health.

These racially disparate outcomes mirror persistent racial gaps nationwide. Babies born to black women are more than twice as likely to die in the first year of life than babies born to white women, and black women are 243 percent more likely than white women to die from pregnancy-related complications, according to the Centers for Disease Control and Prevention.

These statistics aren’t new. What’s new is how some professionals throughout Connecticut—from psychiatric researchers to community activists to medical doctors and progressive health centers—are reframing the way racial disparities are addressed: by re-examining their root causes and coming up with new solutions. This close examination of racial disparities in pregnancy-related outcomes coincides with a recent push to address the nation’s discouraging overall maternal death rates, which increased by more than 25 percent between 2000 and 2014, while those in other developed countries declined, according to a study published in the journal Obstetrics and Gynecology.

New Haven Healthy Start (NHHS), a community-based program, has been working for three decades to identify and eliminate racial disparities in birth outcomes. The organization has examined several factors as possible culprits in the racial divide, including poverty, health insurance, and access to prenatal care. Ultimately, they homed in on one factor.

“Racism. Discriminatory practices based on race. That’s what we’ve been focusing on,” said Kenn Harris, president of the board of directors of the National Healthy Start Association and project director at NHHS. In response, they offer a program where women, regardless of their race, feel truly supported throughout their pregnancy.

Meeting Moms Where They Are

At the heart of NHHS’s simple yet highly effective strategy is its care coordination service model, recruited from places including libraries, laundromats and beauty salons within the communities they serve. They do outreach at strategically located places where pregnant women in the program’s target population are likely to visit, including community health centers and homeless agencies. Every participant is assigned a care coordinator, who provides an array of support—from helping them sign up for state Medicaid to arranging transportation and childcare to reaching out to them if they miss a doctor appointment.

The key to these care coordinators and other employees at NHHS? They look like the women they serve, and, in many cases, they’ve been through similar situations. Natasha Ray, a 49-year-old resident of East Haven, had her first of four children at 16; all her infants were born premature. Now she’s the core service manager at NHHS.

“My interest in the program was personal. Here was a program whose focus is on prematurity, health disparities and strengthening the fragmented system that families must navigate. I feel that this was an opportunity to be the person for so many mothers-to-be that I did not have. When you know better, chances are you will do better,” Ray said.

The approach works. In 1987, one in every 50 infants born in New Haven died in the first year of life. Today, only one out of every 222 infants whose mothers are enrolled in NHHS dies in the first year of life, according to the Community Foundation for Greater New Haven, which runs the Healthy Start program in New Haven. In 2017, 1,402 women were enrolled in NHHS. Of these, 43 percent were black, 38.5 percent were mixed race, 16 percent white, and 2.5 percent Asian.

Another program making a difference in the health of black moms is The New Haven MotherS (MOMS) Partnership. This community–academic partnership, founded in 2011 by Yale associate professor of psychiatry Megan Smith, DrPH, MPH, seeks to improve maternal mental health among low-income women through a community-driven approach.

“We know that depression co-occurs with trauma and anxiety disorders, particularly post-traumatic stress disorders, and that they can increase a woman’s chance of preterm birth,” said Smith, who is also the program’s director.

Smith said she started the MOMS partnership because of increasing racial inequities she observed related to mental health care among New Haven residents. “They’re more likely to drop out of mental health care programs, and less likely to receive high quality mental health care,” Smith said of the women targeted by the MOMS partnership. Since its inception, the program has reached more than 500 low-income moms and pregnant women from New Haven, about 70 percent of whom are women of color.

The program provides outreach to mothers and pregnant women in targeted neighborhoods of New Haven, requesting that they complete mental health assessments. Those who demonstrate need receive cognitive behavioral therapy in familiar settings, including the second floor of the city’s Stop & Shop grocery store and other citywide locations. The treatment setting is non-threatening; so too are the community mental health ambassadors (CMHAs), employees who recruit participants and accompany them to treatment.

CMHAs are mothers from the local community trained to focus on target population outreach and, when deemed necessary, to support mental health treatment. They work alongside traditional mental health clinicians. Most possess customer service experience; they all empathize with the participants’ struggles.

Smith attributes the program’s overwhelming success largely to the ambassadors and the community settings where they serve women. To date, over 70 percent of participants registered for cognitive behavioral therapy through the partnership have adhered to treatment, and more than 50 percent report decreased depressive symptoms.

Carl Jordan Castro Photo

Kimberly Streater with her youngest daughter Nevaeh Lewis, 14, and son Howard Lewis.

Streater, who gave birth prematurely to two of her six children, is a CMHA. She learned about the job when taking a free stress management class about five years ago. Streater says she didn’t have much of a support network as a pregnant or new mom. “It was pretty much me,” she said.

Implementing simple, common-sense practices within existing healthcare systems also lends support that can help close racial gaps in pregnancy outcomes. At Southwest Community Health Center in Bridgeport, about 80 percent of the patients that advanced practice midwife Janet Spinner sees are women of color. She’s pleased about the decisions the center makes to accommodate its patient population’s health needs. For instance, instead of waiting to see patients at the typical six-week postnatal visit, Spinner has new mothers come for a checkup between one and two weeks after delivery, then again at the six-week mark. “That’s when scary post-pre-eclampsia can rear its ugly head,” Spinner said of the dangerous medical condition that occurs more frequently among black women and can happen during or shortly after pregnancy. Spinner also uses the initial postnatal visit to check in with patients about breastfeeding, social support, and intimate partner violence, which she refers to as “the elephant in the room.” And, Spinner says, the Bridgeport health center provides strong diversity training to its employees, a trend she sees becoming more prevalent throughout the state.

“We really need to talk about this as a community,” she said.

Black women might be more likely to go to the doctor’s office when the doctor looks like them. Marcia Tejeda, MD, a black OB/GYN who works in Waterbury, acknowledges that she probably sees 5 to 7 percent more black patients than the other physicians in her group practice—a choice based on her patients’ preferences.

Although Tejeda says she feels all the physicians with whom she works make a “tremendous effort to give all women excellent care,” she does suggest that, in general, doctors and other medical professionals could benefit from education and training that focuses on how to improve their interactions with black patients, including learning how to better understand their culture and improve ways of communicating with them. Tejeda also proposes that race-specific research initiatives occur more routinely.

“Now that we see the mortality rate is higher for black women, we need to do research that’s specially geared toward black women,” Tejeda said. “That will be the key to decreasing mortality for black women and improving outcomes for their babies.”

]]>http://c-hit.org/2018/08/07/strategic-outreach-bridging-racial-gap-in-pregnancy-related-health-outcomes/feed/0Mold Concerns Rise With The Sea Levelhttp://c-hit.org/2018/07/24/mold-concerns-rise-with-sea-level/
http://c-hit.org/2018/07/24/mold-concerns-rise-with-sea-level/#commentsWed, 25 Jul 2018 01:55:42 +0000http://c-hit.org/?p=289117A day after Hurricane Sandy hit, Nancy Arnold waded down her basement stairs and saw five feet of storm surge partially submerging her furnace and hot water heater.

After the water eventually retreated, and the local fire department pumped out the rest, Arnold had another worry: mold. A husband and wife who had done painting for the Arnolds showed up and offered to wash the home’s lower level with bleach. “Where would I have been without that,” Arnold wondered this summer, “because they knew about the mold, and they Cloroxed the whole basement. If there’s another storm, I don’t know if they’re up to do that again.”

Arnold has lived in her house near the end of Whitfield Street in Guilford since 1962. She and her family evacuated to a local community center for six hours during the worst of Sandy’s tempest. Evacuations have become commonplace in her neighborhood, she said. A year prior, during Hurricane Irene, the family also packed their bags and spent the night at the center.

After the Sandy cleanup, Arnold hired a contractor to install a new furnace that hangs from the ceiling, about 5 feet above the floor.

“That’s as high as they could make it,” she said. “If it needs to be higher than that, Guilford’s in trouble. But the way the world is today, who’s to say, you know, what could happen?”

For the past several decades, Arnold has watched the tide creep deeper into the marshes that ripple outside her living-room window. Guilford’s coastal neighborhoods, like most of the shoreline, saw the future arrive with Hurricane Irene in 2011.

In a century, climate change and a rising sea level on Connecticut’s coast have brought more frequent and devastating flooding during storms.

The flooding destroys property, something people hear about immediately. But it also harms people’s health.

After flooding, mold quickly multiplies into fuzzy blobs on walls and furniture. When people try to clean up, they breathe in airborne microbes that can trigger breathing problems, skin rashes and infections, mucous membrane illnesses, and problems in internal organs, according to fungal scientist Eckardt Johanning and his colleagues, writing in an article in Environmental Health and Preventive Medicine.

Terry Brennan/EPA Photo.

After floods, mold quickly multiplies, and exposure to it can make you sick.

Health researchers say that residents should view floods as hazardous to their health and doctors need to beef up their training to recognize flood-related illnesses.

Mold itself can make people sick, but mold also signals the presence of other bacteria and disease, said Paula Schenck, director of the Center for Indoor Environments and Health at UConn Health. She said doctors “can advise their patients to have the appropriate protective gear on hand before the flood, and then avoid exposures that would cause illness, so I’m sort of on a disease-prevention soapbox here.”

“If you live in an environment that is likely to see severe wet weather, it’s good for your doctor to consider if you might have health concerns from exposures after a storm, or from being in a chronically wet environment, when you go in for your yearly exam,” Schenck said.

This little-discussed public health threat—exposure to mold—is rising slowly into the public consciousness. Nuisance flooding has increased on the United States coasts, and it will increase dramatically after 2050, or about the time that today’s babies will be young adults.

People who live near water now live more and more in water.

Adam Whelchel, director of science for the Connecticut Chapter of the Nature Conservancy, has worked on coastal resilience planning with dozens of municipalities. “There’s a whole lot of emotional stress that goes along with living along the coast,” he said.

Around New England, most coastal areas have been inundated several inches over the past century. Bridgeport’s sea level has risen nearly 1 foot, and New London’s slightly less, according to the National Oceanographic and Atmospheric Administration’s (NOAA) calculations. The yearly increase is almost 3 millimeters.

The red line in NOAA’s map indicates land currently subject to flooding at high tide during rain or a storm.

High-tide flooding along the nation’s coastline has increased 300 percent to 900 percent in the last half-century. NOAA’s map of projected high-tide flooding can be zoomed to street-level detail for any town in Connecticut. A perusal of the state shows that inundation by floods will cover large swaths of Guilford south of I-95, and large areas of Madison, Bridgeport, Middletown, Old Saybrook, Haddam, Hartford and Stamford in the future.

Buildings in the floodwaters’ path will be prone to mold and all that mold signifies.

All molds are part of the kingdom of fungi. Scientists haven’t yet identified most fungi that exist—90 percent or so, said De-Wei Li, a research mycologist at the Connecticut Agricultural Experiment Station’s Valley Laboratory in Windsor. Scientists who study fungi spend much of their time simply identifying species.

The hundreds of molds scientists have identified in this part of the world can trigger allergies like asthma and skin reactions, and some of them contain mycotoxins or volatile organic compounds (VOCs) in their spores. Mycotoxins and VOCs can cause serious diseases or reactions when ingested, when they come in contact with skin, or when someone breathes them in. The microscopic spores penetrate deep into the lungs.

Carl Jordan Castro Photo.

The furnace in Nancy Arnold’s home is suspended from the basement joists to prevent potential flood damage.

A month after Sandy hit in the Northeast, scientists collected samples of mold from houses in Brielle and Manasquan, New Jersey. They found 36 types of mold, including six that killed flies in the lab. Molds found included Aspergillus niger, which the CDC reports can cause lung infections and allergic reactions; Aspergilloma (fungus ball); and the most common found in damp or water-damaged structures, Penicillium chrysogenum.

The presence of mold also indicates a whole soup of biological materials, including bacteria. If someone sees mold growing inside, they are witnessing a risk to respiratory health, Schenck said.

She added that flood waters can be dangerously contaminated. Certain medical conditions make one vulnerable to airborne mold.

“Many materials—wallboard, fabrics themselves (clothes, curtains) and those that trap dust (carpet) are a grand meal for mold,” Schenck has written. “Even some well-constructed buildings that haven’t had moisture concerns in the past become wet from wind-driven rain and flood waters in severe storms.” Schenck wants people to know that any time they see mold, they should consider it an indicator that “moisture is available for biological growth.” The wetter it is, the greater the chances of severe respiratory illnesses.

An increase in floods will cause wood and drywall and other building materials to become saturated more often, causing an increase in people’s exposure to airborne mold spores, since that is how they reproduce. This means that people whose immune systems have been weakened by disease are more vulnerable to health effects from mold.

The most urgent advice about a flooded living space is to get out until the standing water has subsided. “Once it’s flooded, don’t go wading unprotected in that environment,” Schenck said.

]]>http://c-hit.org/2018/07/24/mold-concerns-rise-with-sea-level/feed/2Veterans’ Families Also Suffer From The Wounds Of Warhttp://c-hit.org/2018/07/11/veterans-families-also-suffer-from-the-wounds-of-war/
http://c-hit.org/2018/07/11/veterans-families-also-suffer-from-the-wounds-of-war/#respondThu, 12 Jul 2018 02:04:38 +0000http://c-hit.org/?p=284286Growing up, Mary Louise Montini, 13, has often been angry, upset and on edge, just like her father, a veteran with Post Traumatic Stress Disorder (PTSD).

Her experience isn’t unique. Children can develop their own mental illnesses as a result of their parents’ struggles with PTSD and other mental health disorders associated with their military service, professionals say. And there are few resources and programs targeted to veterans’ children, compared to children of active military.

Experts say the treatment needs of veterans’ children will continue as their parents continue to rotate through deployments to conflicts around the world, including in Iraq, Afghanistan and Syria.

A Rand Corporation report called “Bridging Gaps in Mental Health Care” states that mental health challenges in family members can manifest “soon or long after a service member transitions to veteran status.” Of 2.8 million veterans of conflicts in Iraq and Afghanistan, between 18.5 percent and 42.5 percent have mental disorders, the report said. Half of those deployed already had children at that time, it adds.

According to the report, research about veterans’ family members is sparse. There are “very few representative studies of veterans’ family members (spouses and children),” it states.

For the Montini family of Fairfield, the behavior and traumas endured by their father, Nicholas, have been evident through his 17-year-marriage to Kristina. A paralegal, he couldn’t hold jobs for long, often quitting in anger over minor issues. Finances were strained while Kristina was usually the sole financial support.

Agitated in crowds, Nicholas would have to leave a mall, for example, just as the family was enjoying a shopping trip. Anxiety, fear, guilt, depression, sleeplessness and horrifying nightmares took a toll on him and his family. His symptoms were classic PTSD, but he didn’t realize it, even though he was an Air Force veteran of the first Persian Gulf War. He finally sought help five years ago. Now 49, he is getting treatment at VA Connecticut Healthcare and has a job he loves. He is the New England military and veteran’s coordinator for Hope for Warriors, based in New York, which he said is therapeutic for him while enabling him to help others.

Carl Jordan Castro Photo.

Nicholas Montini, 49, served in the Air Force as an M60 Gunner during the first Persian Gulf War. He suffered from PTSD for years and finally sought treatment about five years ago.

“PTSD is an evil thing. It’s just awful,” Nicholas said.

For more than a year, the family has been getting family and individual counseling from a private therapist.

Both children said therapy has helped them understand their father’s PTSD. “I know how to deal with it. I understand it more. I get why it’s happening,” Mary Louise said. Peter, 11, who has attention deficit/hyperactivity disorder (ADHD), agreed. “I know a lot more about how it affects him,” he said. “The stuff that happens with Dad, I avoid it.”

Mary Louise has anxiety but has become less withdrawn and more social with the help of therapy, her mother said. She’s also the person Kristina vents to about their family’s issues because Kristina doesn’t know others who would understand.

Private therapy is the main source of mental health help for veterans’ families since health care provided by the U.S. Department of Veterans Affairs (VA) is mainly geared to veterans. Therapy can be expensive. Many providers don’t take insurance. In addition, they often aren’t acquainted with military and veterans’ culture.

The Montinis’ therapist takes insurance, but because of the cost of the co-pay, the family restricts visits to every other month, Kristina said.

The Montini family — Nicholas, Mary Louise, Peter and Kristina — has received family and individual counseling.

One such organization is the Cohen Veterans Network, founded and financed by billionaire Steven A. Cohen and headquartered in Stamford. It provides free or low-cost mental health counseling at 10 sites in the country, with a goal of expanding to 25. There are no treatment locations in Connecticut. The closest is at New York University’s Langone Health, which also offers teleconferencing counseling to Connecticut veterans and their families and to veterans who aren’t eligible for VA care.

Anthony M. Hassan, president and chief executive officer of Cohen Network, called for other philanthropists to fund programs like Cohen’s. He said it’s the only hope for meeting the needs of this population.

Hassan said that because of the lengthy wars in Iraq and Afghanistan, “one child can actually have grown up their entire life with their parent or parents impacted by war and deployment.” He said “family members can’t help but be impacted,” but added that “families are often an afterthought.”

Another resource is Give An Hour, an online state-by-state directory of licensed therapists who will donate at least one free hour of counseling to a veteran or family members. The service is anonymous and confidential. The therapists have a background in treating trauma and aren’t required to have experience treating veterans but are encouraged to participate in training about military culture, said Nancy Rice, chief operating officer.

Home Base, based in Boston, provides residential and outpatient treatment to veterans and services to families. It has served a few Connecticut veterans and family members in Boston and trained nearly a thousand Connecticut clinicians in military and veterans’ culture, according to a spokesperson.

Carl Jordan Castro Photo.

Mary Louise and Kristina say they often find themselves in the kitchen, venting and talking about each other’s day.

The history of mental health repercussions for veterans’ family members is long, advocates say.

Maria Phillips of Clinton, whose father served in World War II, said she and her siblings have mental health issues that include anxiety, depression and obsessive-compulsive disorder, which she called “collateral damage” from their father. She said he had what was then called “shell shock” with symptoms similar to what is now identified as PTSD and traumatic brain injury.

Phillips used her father’s veteran’s death benefit money to co-found Kids of America’s Heroes, which, among other things, teaches educators and community leaders in the state about issues confronting children of veterans and active service members.

Roni Avinadav, a clinical psychologist at the Cohen clinic at NYU, developed a training protocol to help parents “understand how their trauma history is affecting their lives and their children.”

“It’s clear there is a need” for more mental health services for veterans’ families, she said, adding “whatever can be done to help these families, they deserve more.”

]]>http://c-hit.org/2018/07/11/veterans-families-also-suffer-from-the-wounds-of-war/feed/0Poor And Minority Women Face Widening Barriers To Depression Treatmenthttp://c-hit.org/2018/07/02/poor-and-minority-women-face-widening-barriers-to-depression-treatment/
http://c-hit.org/2018/07/02/poor-and-minority-women-face-widening-barriers-to-depression-treatment/#respondMon, 02 Jul 2018 12:15:38 +0000http://c-hit.org/?p=280876Among women, those who are low-income or minority are less likely to get treatment for depression, according to multiple studies.

A report by the Connecticut Behavioral Health Partnership found that women were underrepresented in Medicaid-funded behavioral health services in the state even though research shows that women suffer from the most commonly diagnosed mental health disorders more frequently than men.

Racial and ethnic disparities, while still considerable, are decreasing in some physical illnesses. “But in mental health care, in the last 10 years, we see those disparities widening,” said Megan Smith, associate professor in the Departments of Psychiatry and in the Child Study Center in the Yale School of Medicine, who runs the Mental health Outreach for MotherS (MOMS) Partnership®, a program that offers mental health services to “overburdened and under-resourced mothers.”

In this podcast, sponsored by ConnectiCare, Colleen Shaddox discusses the hurdles to mental health care and the programs breaking barriers to care with Yale’s Megan Smith and UConn Health’s Dr. Sarah Nguyen.

Lack of insurance coverage, the cost of treatment, a shortage of qualified clinicians, stigma and even fear of losing custody of their children can keep women from seeking help, Smith said. Blacks and Hispanics are more likely to report psychological distress than non-Hispanic whites, and the rates increase dramatically for minorities who live in poverty, according to the Centers for Disease Control and Prevention. But white women are using mental health services at more than twice the rate of black or Hispanic women, data from the federal Substance Abuse and Mental Health Services Administration show.

“Unfortunately, lack of health insurance is often the biggest barrier to receiving care for depression. And with the lack of insurance there are financial barriers that come into play,” said Dr. Sarah Nguyen, a psychiatrist and faculty member at the University of Connecticut School of Medicine.

Yale School of Medicine Photo.

Megan Smith, associate professor in the Departments of Psychiatry and Child Study Center, Yale School of Medicine.

More than 42 percent of adults who do not get needed mental health treatment said they cannot afford it, according to the National Survey on Drug Use and Health. Medicaid does not reimburse clinicians for the full cost of mental health treatment, creating a shortage of providers who accept Medicaid. A 2015 study found that Connecticut clinicians experience a $27 million annual loss versus standard fees when providing mental health care under Medicaid.

There is also a shortage of clinicians who are minorities. “I think it goes back to increasing the human capital in the mental health field,” Smith said. “What I mean by that is really increasing the training and the availability of providers who are of racial and ethnic minority background themselves, and of providers who accept Medicaid and sliding scale, and, particularly, providers who are using evidence-based treatments. We know we have to be concerned about the quality of care, and so we want to, of course, lift up the quality of care that everyone receives.”

And then there is stigma, which is blamed for keeping people out of treatment regardless of background. Research shows that pressure to be “a strong woman” and a reliance on faith communities and other sources outside of health care providers discourage black women from seeking depression treatment.

Women who use the MOMs program often do not even use the word depression. “Stress is actually the way that many mothers we talk to describe depression,” Smith said. “So, mothers will talk about stress and really mean anxiety, trauma, addiction, depression.”

Women can access MOMs services at places like the laundromat. They can even get therapy at the local Stop & Shop. “The feedback we have from mothers on that is excellent,” Smith said. “They really like receiving care there. They feel safe. They feel secure, and it really feels like part of the community.”

One day a week Nguyen practices in a primary care center and sees patients she says would never have come to her psychiatry office to begin therapy. “Once I’ve established a rapport and a relationship with [patients] they’re more open to seeing me in other clinics,” she said.

Being in the primary care clinic is a particularly good way to get immigrant women into treatment, Nguyen added, because immigrants with depression are more likely to come in complaining of a physical problem like a stomach ache.

Tina Encarnacion/UConn Health Photo.

Dr. Sarah Nguyen, a psychiatrist at UConn Health.

Fear surrounding immigration status keeps some people from seeking depression treatment and so does fear of losing custody of a child. Smith stressed that mothers around the country do face child welfare systems that can penalize them for mental illness, but she offered assurances that Connecticut is different. “I think what’s helpful in Connecticut is that our child welfare system is informed about brain science and child development and knows the importance of promoting that dyadic relationship between mothers and children,” she said.

Though financial barriers can keep women out of care, Dr. F. Carl Mueller, associate chair of psychiatry at Stamford Health, urges women not to assume that care is out of reach. “There’s a lot you can do,” he said. “This is not necessarily an expensive proposition. There are short-term treatments that get people out of the darkest places.” He added that treating depression can be essential to avoid lost wages and even job loss. “Depression kills income,” he said.

There is a 50 percent increase in employment among women who get mental health treatment through MOMs, Smith said, citing “a real link between mental health and wealth.”

This is Part 2 of C-HIT’s series on women and depression, sponsored by ConnectiCare.Part 1 is available here.

]]>http://c-hit.org/2018/07/02/poor-and-minority-women-face-widening-barriers-to-depression-treatment/feed/0Depression Affects Women At Twice The Rate As Menhttp://c-hit.org/2018/06/19/depression-affects-women-at-twice-the-rate-as-men/
http://c-hit.org/2018/06/19/depression-affects-women-at-twice-the-rate-as-men/#respondWed, 20 Jun 2018 01:51:12 +0000http://c-hit.org/?p=274831Depression is the leading cause of disability worldwide, according to the World Health Organization, and affects women at about twice the rate that it does men.

In Connecticut, 21.4 percent of women report experiencing depression, compared with 13.4 percent of men, according to 2015 Department of Public Health data.

Millennial women in the state experience depression four more days in an average month than their male counterparts, the Status of Women data project reported this year.

Women are more likely to use mental health services than men, but studies consistently show that the majority of Americans with depression go untreated.

Though the stigma around mental illness has lessened, experts say that it still keeps women from getting help. “I think we’ve made some inroads in that regard, but I think that still exists. It’s very important for people to understand that this is not a failure, this is really a biological illness, and that if you’re having symptoms, it’s really important to get help,” said Carolyn Mazure, director of Women’s Health Research at Yale.

Robert Lisak Photo.

Carolyn Mazure, head of Women’s Health Research, Yale School of Medicine.

Women are prone to depression, often triggered by hormones, such as during the post-partum period, but research suggests that women have a different biological response to stress throughout their lives that contributes to higher rates of depression, according to Mazure.

Biology is not the whole story. Mazure pointed out that women on average have less money and more caregiving responsibilities than men.

Dr. Carl Mueller, associate chief of psychiatry at Stamford Hospital, said that in the workplace women often have “responsibility without authority,” a stressful, no-win situation.

Girls and women are also sexually abused at higher rates. More women are coming in for treatment as the #MeToo movement brings up old trauma, Mueller said. “It is empowering,” he said. “People would like to address those issues that sometimes have tormented them for years.”

Connecticut author Luanne Rice, who writes about her depression, recalled how the stigma made it difficult to get help. She missed a lot of school growing up in the 1960s. “I couldn’t say, ‘I feel down. I feel depressed,’” she said. “Nobody used that word back then. Or if they did, it wasn’t in my family.”

Rice said she was sexually abused as a child by a trusted adult. She was also burdened by a precocious sense of responsibility for keeping her family together, though her beloved father’s alcoholism put enormous strain on her parents’ marriage. Finally, a teacher at her high school saw that Rice was depressed and urged her family to get her counseling. “They were aghast,” Rice remembered. “They were ashamed. They didn’t know that this could ever happen to their child and they said, ‘Well you can see a counselor as long as you don’t talk about the family.’”

Another significant factor in women’s depression is “rumination.” Research shows that women are more likely to turn problems over in their minds repeatedly. This can worsen depression. One of the goals of therapy is often to replace rumination with other coping skills—to change the tape that is playing inside the patient’s head. In addition to cognitive strategies, medication is a common treatment. The most popularly prescribed class of antidepressants, SSRIs, have been shown to be more effective in women than in men.

Kristina Loggia Photo.

Best-selling author Luanne Rice.

Rates of depression in the country are rising, particularly among adolescents and seniors, noted Dr. Sarah Ngyuen, an assistant clinical professor at the University of Connecticut School of Medicine, but rates of treatment are not. She said a large volume of research shows that financial barriers play a big role in keeping people out of treatment. But like other medical professional interviewed, she believes that stigma also stops people from getting help.

“I’m the assistant women’s golf team coach for Yale University. So, I get to interact on a weekly basis with very lovely, ambitious, athletic student athletes,” Nguyen said.

“And I do see that in talking about barriers and stigma, even though Yale is a pretty open community and this is well talked about, it’s still somewhat stigmatized. And I see the shame and embarrassment sometimes that is carried with having depressive symptoms or anxiety. And there is this mentality of what I’d like to term destructive perfectionism, where I think the society and culture that we live in kind of fosters heightened anxiety and depression as a result,” Nguyen said.

The main character of Rice’s latest young adult novel, The Beautiful Lost, is Maia a teenager with depression. The book has an afterword, where Rice shares her own story and encourages readers who have depression to get help.

“That’s a big first step…to be able to reach out and talk to someone,” she said.

Psychologist Carolyn Mazure Says When Sadness Doesn’t Go Away

•Don’t try to hide it. Talk with someone you trust about how you feel.

•You may not click with your first therapist. Your first medication may not help. That’s OK. There are lots of options. Keep looking until you find the one that works for you.

]]>http://c-hit.org/2018/06/19/depression-affects-women-at-twice-the-rate-as-men/feed/0Costs And Access Still Barriers To Health Care, Survey Findshttp://c-hit.org/2018/06/05/costs-and-access-still-barriers-to-health-care-survey-finds/
http://c-hit.org/2018/06/05/costs-and-access-still-barriers-to-health-care-survey-finds/#respondWed, 06 Jun 2018 02:00:03 +0000http://c-hit.org/?p=268834Iasiah Brown, 25, of New Haven, said he does not see a need for a primary care doctor for himself and his daughter, opting to visit clinics in the area instead of waiting up to two weeks for an appointment at a doctor’s office.

Brown is among the 83 people who said they didn’t have a primary care doctor in response to a health-care usage survey by the Conn. Health I-Team and Southern Connecticut State University. The team surveyed 500 people and interviewed dozens statewide between January and March.

About 83 percent of respondents said they had a primary care doctor, but the rate was lower for African American (78 percent) and Hispanic respondents (75 percent). Meanwhile, white respondents were more likely than the average—at 88 percent—to have a primary care doctor. These numbers have decreased since 2015, when C-HIT conducted a similar survey. In 2015, 93 percent of whites, 84 percent of African Americans, and 86 percent of Hispanics had a primary care doctor.

What residents had to say about their health care, hosted by SCSU student Michael Riccio.

The survey results highlight health care disparities between wealthier residents and those in lower income brackets, and between white respondents and minorities—findings that mirror those of the 2015 study.

In general, white residents and those making more than $50,000 a year were more likely to have health insurance and use it. Those over 50 years old in both groups were more likely to have undergone a colonoscopy. The wealthier respondents more often lived close to their primary care doctor.

But in some cases, those making below $50,000, and people of color, were more likely to have had some preventive care screenings, such as chest X-rays for smokers, screenings for depression, and interventions from doctors regarding their weight.

About 110 people said even though they had insurance, there were barriers preventing them from accessing health care. Of those, 54 cited co-pays, 39 said time or travel expenses, and 17 said there was a language barrier to accessing health care.

For Natasha Gerasimopoulos, 36, of Milford, the problem is finding a doctor covered by insurance. Gerasimopoulos, who is insured through Husky Health along with her son, doesn’t have co-pays for her office visits, but she said it’s hard to find specialists who take Husky.

“The doctors’ offices will say ‘Oh, we don’t take that insurance,’ or ‘We stopped taking it a long time ago’,” Gerasimopoulos said. Or, she said, if she can find a doctor who takes her insurance, the office is far from her home.

Most people, at 92.6 percent, reported having health insurance for 2018. But Hispanics and blacks were less likely to have health insurance, at 80.2 percent and 89.2 percent, than whites, at 97.7 percent.

More people reported being uninsured than in the 2015 survey, when 3.6 percent said they had no medical insurance. Connecticut’s uninsured rate for 2016, the most recent numbers available from the National Center for Health Statistics, was 5.8 percent.

Recent changes to the Affordable Care Act, first enacted in 2010, have negatively impacted health care access, according to Pat Baker, president of the Connecticut Health Foundation.

An example, she said, is a change in the number of state residents who qualify for Medicaid.

“Originally Medicaid in Connecticut covered individuals up to 185 percent of poverty,” Baker said. “What we saw happening since 2015 is that has been reduced to 155 percent of poverty, with the rationale that all those [excluded], about 18,000 people, could go get coverage through the exchange, Access Health CT.”

Instead, Baker said, only 20 percent of those dropped by Medicaid were able to purchase insurance through the exchange. The Connecticut Health Foundation and Access Health CT believe cost was a major factor, as survey respondent Beverly Malerba of Ansonia said. “I can’t afford it, really,” she said. “I wish [health care] was universal, like they have in Canada.”

“What remains consistent is the disparate rate between the connection to care between the majority population and people of color, particularly African Americans,” Baker said.

• 3 percent said they had private insurance, but didn’t indicate how they received it; and

• 1 percent are insured through both Medicaid and Medicare;

One of the barriers to care is travel time to a doctor, especially for those earning less than $30,000 annually.

Half of the respondents made more than $50,000 a year, and 56 percent were women. The respondents skewed younger, with 65 percent responding they were in their 40s or younger, and 29 percent in their 20s. About 53 percent of respondents were white, 20.7 percent were African American and 19.5 percent were Hispanic.

Women’s preventive care results were mixed. Overall, 87.7 percent of women over 40 had received a recommended mammogram in the last year, and 77.4 percent of women over 20 had received a recommended Pap test.

Women making more than $50,000 were more likely to have received Pap tests. But the results for women over 40 who had received mammograms in the last year were split on income levels. Those making $100,000 or more were most likely to have had a mammogram in the last two years (93 percent), but those making less than $30,000 were close behind (89 percent).

Black women were the most likely to have received a mammogram (93 percent) and Pap tests (91 percent). White respondents stated they had received recommended mammograms at 89 percent, and Pap tests at 76 percent. For Hispanic women, the results were 75 percent and 71 percent, respectively.

In dozens of interviews, Connecticut residents spoke of the challenges with their health care.

Like Steven S. Siebold, 44, of Trumbull, who said he pays a high premium for his healthcare—about $1,400 a month.

“It’s terribly expensive for what I get,” Siebold said.

Maria Zhumi, of New Haven, said while she has health care through the exchange, she hasn’t been able to get her 9-year-old daughter on the plan because she doesn’t have a Social Security number. Zhumi said she has been paying for her daughter’s health care out of pocket.

Confusion over her citizenship status is preventing Mayelin Jimenez of New Haven from obtaining health care, she said. When she lived in New York, she paid for private insurance, she said, but canceled that policy when she moved to New Haven in November. When she tried to obtain HUSKY insurance, she was told she had to have been living in the U.S. for five years to meet Connecticut’s eligibility requirements. Jimenez said she must wait until July before she qualifies for HUSKY benefits.

“What if I have an accident?” she asked. “I have no insurance.”

Laurinda Bernardo, 65, of New Britain, said rising deductibles have caused stress for her family. Her 2-year-old granddaughter has mitochondria depletion syndrome and requires constant care. Bernardo’s daughter had good insurance, but it still came with a $5,000 deductible. The next year, the deductible increased to $6,000.

“So that year she ended up paying $16,000 just to have the bills paid,” Bernardo said. “Who has that kind of money just sitting around?”

Barbara Collado, a mother of three from New Haven, has had HUSKY A insurance for around 10 years, ever since she moved to Connecticut from Puerto Rico.

In an interview conducted in both Spanish and English, Collado said her HUSKY coverage helped as she and her children have undergone evaluations for health issues. Collado said HUSKY paid for everything. The experience, she said, changed how she viewed her health, and she began seeking health care regularly at her primary clinic, the Cornell Scott-Hill Health Center.

Collado said, however, that it takes her two buses to get to the Hill Center. When the bus is late, she’s late for her appointments. But it’s worth it to Collado.

Southern Connecticut State University students who worked on this project, under the supervision of Assistant Professor Jodie M. Gil

]]>http://c-hit.org/2018/06/05/costs-and-access-still-barriers-to-health-care-survey-finds/feed/0Sickle Cell Patients Suffer As Disparities In Care And Research Persisthttp://c-hit.org/2018/05/10/sickle-cell-patients-suffer-as-disparities-in-care-and-research-persist/
http://c-hit.org/2018/05/10/sickle-cell-patients-suffer-as-disparities-in-care-and-research-persist/#commentsThu, 10 May 2018 19:46:14 +0000http://c-hit.org/?p=254168When 9-year-old Jeremy Brown is in pain, it feels like he is being stabbed, while the pain experienced by Deborah Oliver, 40, is like a hundred simultaneous charley horses.

Brown, of Bridgeport, and Oliver, of New Haven, have sickle cell disease (SCD), a genetic blood disorder that causes excruciating pain, life-threatening complications and a shortened life expectancy. Almost one-half of sickle cell patients die in their 40s.

The disease affects some 100,000 Americans, about one in 365 African Americans and one out of 16,300 Hispanics; and in lesser numbers, people with Middle Eastern, Indian, Caribbean and Mediterranean ancestries. An estimated 2,000 people in Connecticut have SCD.

But the disease—discovered over 100 years ago—receives little research, funding and attention.

• Just two medications have been developed to treat the disease: hydroxyurea, approved in 1998; and Endari, approved in 2017.

• There is no national data registry for tracking the disease.

• Only four of the state’s 27 acute care hospitals have sickle cell treatment programs. And the last SCD awareness program by the Department of Public Health (DPH) was in 2007.

• A 2013 study in the journal Blood reported that cystic fibrosis, which affects 30,000 people nationally, receives seven to 11 times more funding per patient than sickle cell disease. The amyotrophic lateral sclerosis (ALS) challenge in 2014 raised more than $115 million for about 20,000 patients in the U.S. The bulk of the funds—$77 million—were allocated for research.

“I think it’s ignored because it’s predominantly a disease of inner-city African Americans,” said Dr. William Zempsky, a pain specialist at Connecticut Children’s Medical Center in Hartford, which treats children with SCD.

Derek Torrellas Photo.

Deborah Oliver at her home in New Haven. She was diagnosed with SCD at 4 years old.

The other treatment programs are at Yale New Haven and Bridgeport hospitals and UConn Health in Farmington. In total, they treat about half of the state residents with SCD, estimated Dr. Biree Andemariam, the UConn program director. There are no hard statistics on adults with SCD born before 1990, when the state started testing newborns for it. More than 660 babies were born with it from 1990 to 2017, according to DPH.

Andemariam said that about 1,000 patients get no care or go to emergency rooms when in crisis. She and Zempsky created an ER treatment protocol for hospitals without sickle cell programs but none of the Connecticut ERs they approached use it, she said.

Advocates say poor ER care has caused deaths due to lack of knowledge about SCD. Virginia Pertillar, executive director of Citizens for Quality Sickle Cell Care, said patients endure harmful, “unnecessarily long waits,” are accused of seeking opioids “to get high, not to relieve pain,” and are “mistreated or maltreated.”

“Quite honestly, because this primarily affects people of color in this country, some of the disparities in care and research dollars and pharmaceutical interests are intertwined with our country’s history of the marginalization experienced by people of color,” Andemariam said.

Dr. Gregory Buller, Bridgeport Hospital’s chief of medicine, said most SCD patients don’t have the income or clout to raise awareness, with many on disability or a limited work schedule. “If Warren Buffett had sickle cell disease, then the approach to it might be a whole lot different,” he said.

Treatment

In SCD, blood cells are sticky and deformed, causing clots, hampered blood flow, intense pain and, potentially, strokes, organ damage and breathing problems. Most adult patients have chronic pain. Children and adults have pain crises that erupt unpredictably and can last more than a week.

Bone marrow transplants are the only cure, but they’re risky and limited to very sick people who can find a donor match and who don’t have organ damage. Yale New Haven Children’s Hospital has done about a dozen successful transplants, said Dr. Farzana Pashankar, a hematologist-oncologist who specializes in SCD.

Pashankar said the hospital has expanded potential donors from siblings to also include parents and nonrelatives so more patients can be eligible for transplants.

University of Illinois Hospital doctors reported in April that they cured seven adults of SCD by using stem cells from family donors who previously would have been considered incompatible because their cells were only partial matches. One patient has died.

In Paris, doctors reported that they have cured a boy with SCD using gene therapy. Scientists have called this development encouraging and promising but needing long-term follow up and more cases.

Treatments include opioids, transfusions, and the two SCD-targeted medications, hydroxyurea and Endari.

Jeremy Brown, a third-grader who wants to be an actor, has the most severe and debilitating form of SCD. Two years ago, he began taking hydroxyurea, a chemotherapy drug. He has been hospitalized once since. Before that, he was hospitalized at least monthly starting when he was 6 months old, said his mother, Tangi Small. Her husband lost a job after absences due to Jeremy’s hospitalizations. The couple and their four children became homeless, living in transitional housing for three years.

Derek Torrellas Photo.

Jeremy and his parents, Tangi Small and Jersino Brown, at their home.

Jeremy has endured intense pain in his arms and legs, fever, a distended stomach, bulging eyes and pneumonia. He can’t gain weight. Twice he couldn’t breathe on his own and was connected to a machine that removed some sickle cells and replaced them with normal ones. He has been prescribed morphine and oxycontin.

Oliver, a clinical technologist, has a different strain. She has pain crises about once a year, for which she is hospitalized and gets blood transfusions. She had her gall bladder removed and a hip replacement due to SCD complications. She limps from bone deterioration in her other hip. She is frequently online, searching for SCD advice from other patients. She was diagnosed when she had pneumonia at age 4.

“I’m not afraid to die,” Oliver said. “That’s not a fear. My concern is not fulfilling whatever my purpose is. I try to live each day as if it’s my last. I try to get the fullness of each day. I have no regrets.”

Connecticut SCD program directors said they are reducing hospitalizations with outpatient care, including individualized care plans, managing pain and reducing stress with psychiatric care and social work counseling, non-opioid medications, and self-management of opioid use, depending on need.

Roberts said that in 2015, advocates successfully lobbied to include SCD among the debilitating illnesses eligible for treatment with medical marijuana. It was not included in the 2012 state law.

The median life expectancy for SCD is 42 for men and 48 for women, according to Kathryn Britos-Swain, state sickle cell coordinator. Fewer children are dying, but adult mortality is not improving. A study by investigators at Johns Hopkins University School of Medicine showed it got 1 percent worse each year between 1979 and 2005.

Derek Torrellas Photo.

Jeremy Brown and his cousin, Denosh Billie, 12, color at home in Bridgeport. Denosh also has SCD.

“This is obviously a concern to families living with sickle cell disease and to sickle cell physicians,” Roberts said.

Small said she cried when her son was diagnosed “because I knew people who had it and passed early.” Four of her friends died from SCD at ages 17, 18, 21 and 32.

Pharmaceutical company interest in funding research has risen, but it is still difficult to get funding, Andemariam said, citing her inability to obtain funding to complete her work on SCD patients’ trauma.

Zempsky predicted better treatment options in the next decade as a result of new research. But, he said, “right now, the status quo is not very good.”

]]>http://c-hit.org/2018/05/10/sickle-cell-patients-suffer-as-disparities-in-care-and-research-persist/feed/1Street Medicine: Helping The Homeless Where They Livehttp://c-hit.org/2018/04/25/street-medicine-helping-the-homeless-where-they-live/
http://c-hit.org/2018/04/25/street-medicine-helping-the-homeless-where-they-live/#commentsThu, 26 Apr 2018 02:00:37 +0000http://c-hit.org/?p=250721Homeless people tend to have trust issues, but when Phil Costello approaches they typically greet him like family. That’s because Costello, the clinical director for homeless care at Cornell Scott-Hill Health Center in New Haven, puts effort into building relationships and trust so he can get people the medical care they need.

Quentin Staggers, homeless for nearly a decade, credits Costello with saving his life. He awoke one day on a bench on the New Haven Green with a blinding headache. He saw Costello and asked for help. Costello took Staggers’ blood pressure—a frightening 200 over 167—and sent him to a clinic, where he got medications to stabilize his condition.

“If it wasn’t for him taking my blood pressure right then and there, I probably would have had a heart attack,” Staggers says.

Some of New Haven’s homeless call Costello the “street doctor.” And while he’s an advanced practical registered nurse (APRN) rather than an MD, he and his team provide on-the-spot medical care for homeless people where they are—in soup kitchens and shelters, in parks and under bridges, and on some of New Haven’s meaner streets. They send people to the clinic for more serious issues, including mental illness and drug addiction. They run one of the most extensive such outreach programs in the state.

Cornell Scott’s program is part of a movement that is gathering steam across Connecticut. In Hartford, Stamford, Bridgeport, Norwalk, Danbury and other cities, health care providers are collaborating with housing advocates and others to offer better care for homeless people. They’re reaching out to provide people the shelter, food and medical care that can improve the quality of their lives, and, potentially, bring them back into the mainstream.

At the same time, these organizations hope to reduce the high cost of providing health care for a hard-to-serve group. Roughly 40 percent to 45 percent of the most frequent visitors to the state’s hospital emergency rooms are homeless, according to a 2017 study by the Partnership for Strong Communities. For instance, one homeless man visited Norwalk Hospital 110 times in a single year. At more than $1,000 per incident, the cost of those visits quickly adds up. Experts say the state could save tens of millions of dollars per year by treating people on the street or in clinics instead.

“When Phil and the outreach team provide care in the field, it can prevent a whole series of ER visits and inpatient hospital stays at exponentially greater cost,” says Michael Taylor, CEO of Cornell Scott.

Those cross-agency collaborations help, too.

Seven years ago, officials at Middlesex Hospital realized they had to respond to overuse of the ER by homeless people. It was expensive and disruptive. They created the Middlesex County Community Care Team (CCT) to coordinate services for the most frequent users of the hospital.

Today that CCT includes representatives from 14 community organizations, including health care providers, soup kitchens and shelters, housing placement agencies, and the state Medicaid system, which funds health care for poor people. They meet weekly, identifying frequent users of the ER, getting their permission to share information about them, and developing individualized plans for health care, housing and social services. “We all work together to get the person what they need and to get them functioning again,” says Terri DiPietro, director of Outpatient Behavior Health Services at Middlesex Hospital.

The Middlesex CCT has delivered impressive results. In the first year, 2013, ER visits by high-frequency users were reduced by 63 percent. In 2016, approximately $1.7 million in ER visit costs were avoided.

Not surprisingly, the community integrated care model is spreading across the state, with activities in 15 communities now. “Every community is waking up to the need for this,” says Terry Nowakowski, chief operating officer for the Partnership for Strong Communities in Hartford.

The CCTs have produced many success stories. In Danbury, a man who had been living in a van and was poisoned by using a camp stove for warmth, is now housed, on medication for hypertension and looking for a job. “We’re not done with him, either,” says Kevin McVeigh, a social worker with the CCT who helps homeless people navigate community services. “We’ll continue to monitor him and help him when he needs it.”

Over the past few years, the state has made substantial progress in finding long-term housing for homeless people. The population dropped from 4,450 in 2014 to 3,387 last year, down 24 percent, according to the Connecticut Coalition to End Homelessness.

Still, there’s a lot of suffering so it’s important to expand the health care safety net. People exposed to the elements and lacking routine medical care get sick more often and stay sick longer. And, since they often have multiple health problems, treating them tends to be complicated. Ultimately, “they die expensive deaths,” says Middlesex Hospital’s DiPietro.

Health care leaders say they’re hampered by rules for providing and paying for services. Medicaid, for instance, reimburses for those expensive ER visits, but money is tight when it comes to paying for preventive care. “It’s penny wise and pound foolish if you don’t provide preventative and routine care, and people end up in the ER,” says Dr. Charles Herrick, chair of psychiatry at Danbury and New Milford hospitals. “This is where our country is struggling.”

The Connecticut Hospital Association estimates that the state could save up to $28 million in Medicaid-reimbursed ER costs per year if all of 23 regions adopted the CCT program. While the general assembly approved $4.5 million to support CCTs in 2015, the money was never spent due to budgetary shortfalls.

Now, because of looming budget cuts at the state and federal levels, money is going to get even tighter, so health care leaders say they’re relying on ingenuity to get things done. To stretch dollars, the Cornell Scott team is recruiting volunteer medical students and retired clinicians to bolster their street medicine program.

For Cornell Scott’s Costello, the medical care his team provides is part of an even higher calling. He says, “Whether you can make people better or not, the important thing is to treat them with respect, to provide an open ear, and to be there in their moment of need so you can provide some comfort.”

]]>http://c-hit.org/2018/04/25/street-medicine-helping-the-homeless-where-they-live/feed/1Hospitals Bill More Than $1 Billion In Facility Fees Over Two Yearshttp://c-hit.org/2018/04/12/hospitals-bill-more-than-1-billion-in-facility-fees-over-two-years/
http://c-hit.org/2018/04/12/hospitals-bill-more-than-1-billion-in-facility-fees-over-two-years/#commentsThu, 12 Apr 2018 09:34:42 +0000http://c-hit.org/?p=242826Connecticut consumers were billed for more than $1 billion in facility fees for outpatient services in 2015 and 2016, documents filed with the state Office of Health Care Access (OHCA) show.

Twenty-two of Connecticut’s 30 hospitals charged these fees, bringing in $600.7 million in 2015 and another $488.8 million in 2016, according to an analysis by Conn. Health I-Team.

The state’s two largest hospital systems, Yale New Haven Health and Hartford HealthCare, accounted for almost half of the total facility fee revenue in 2016. Yale and its four hospitals billed $144.3 million; Hartford and its five hospitals, $80.9 million. Stamford Hospital charged $118.2 million, the most of a single hospital.

Photo Stamford Hospital

Stamford Hospital charged $295.9 million in facility fees over two years.

Patients have long complained about facility fees, which hospitals charge for outpatient services at facilities they own to cover operational expenses. Of the 1.4 million outpatient visits in 2016 facility fees were charged for everything from five-minute office visits to diagnostic tests such as MRIs and mammograms.

Connecticut, which had earned an F from health advocates for its lack of transparency in medical costs, passed a law in 2015 requiring hospitals to notify patients if they will be charged a facility fee. Hospitals must clearly identify facility fees in bills, notify patients if they acquire a physicians’ group and file an annual report with OCHA on how much they earn in fees.

Patient advocates say that the law has made consumers more aware of the fees, but it is often confusing for patients who get a second bill for hundreds or sometimes thousands of dollars for care.

The fees are paid by consumers, their private insurance, Medicaid or Medicare.

Doolittle says his staff is currently working a few cases where patients were charged large facility fees, including a woman who received outpatient surgical care and expected to pay a $50 co-pay and was hit with a $930 facility fee.

West Hartford resident Leslie Silverman said she took her 15-year-old daughter to their doctor’s office to get blood drawn for a tendon in her ankle that wouldn’t heal in 2014. The doctor’s office had difficulty drawing blood and sent her to the West Hartford Surgical Center, which is owned by Hartford Hospital.

“We had no idea we were going to get walloped with a $1,200 facility fee, it cost four times as much as we thought,” said Silverman, who added that because it was part of an experimental procedure not covered by insurance, they paid the fee out-of-pocket.

“Our doctor wasn’t trying to mislead us; it just wasn’t on anybody’s radar,” she said. “We went there because our doctor said we have to do this and then we see the bill and we go, ‘Whoa.’”

Hospitals say facility fees are necessary to upgrade infrastructure costs. “Generally, when a facility becomes part of a hospital, the technology, including software and hardware, must be of a certain standard,” said Michele Sharp of the Connecticut Hospital Association. “Additionally, these facilities must have emergency stand-by capacity and meet more stringent regulatory requirements. As a result, the infrastructure costs associated with hospital-owned facilities are greater than the costs of a standalone office.”

Patient advocates say the public filings are a step in the right direction, but there’s a long way to go.

“As a consumer representative, it’s flabbergasting,” said Lisa Freeman, executive director of Connecticut Center for Patient Safety. “We’re paying more and more and we can’t figure out how much it will be ahead of time.”

What The Filings Reveal

In 2016, Connecticut hospitals charged facility fees at 184 off-campus facilities, the reports show. Some of the most frequent types of care that patients were charged facility fees for include radiation treatment, echocardiograms, sleep disorder testing, colonoscopies and mammograms.

Ellen Andrews, executive director of the Connecticut Health Policy Project, says the fact that mammograms are among the most frequent service for which facility fees are charged is “stunningly stupid.”

“A mammogram is preventive care,” she said. “Every time you institute another hassle and you make it harder to go to the same place you’ve always gone, you are going to get some people who just don’t go through the trouble. So, if it’s a problem for people getting preventive care, that’s really penny wise and pound foolish.”

The fees that caused the most outrage a few years ago were facility fees charged at doctor’s offices owned by hospitals. According to a 2014 report by Attorney General George Jepsen, facility fees became more common as hospitals acquired physicians’ practices. Patients complained about showing up to the same doctor they’ve seen for years, expecting to pay the same co-pay as always, but were later hit with a big facility fee.

Yale New Haven Hospital charged $103.1 million in facility fees in 2016.

Some hospitals will feel the impact of this change. In 2016, Yale New Haven earned $9.9 million for five-minute outpatient visits—its highest facility fee charged—which is now banned.

Congress also tightened regulations on facility fees in its 2015 budget by limiting what hospitals can charge at facilities acquired after Jan. 1, 2017.

There are signs that hospitals got the message, too. A spokesman for Hartford HealthCare said that as they’ve grown they’ve tried to employ physicians at outpatient facilities through the Hartford HealthCare Medical Group rather than through one of their hospitals so their patients won’t be hit with extra fees.

“This helps us limit facility fees for patients,” said Hartford HealthCare spokesman Shawn Mawhiney. “We do our best to limit the financial impact on our patients. In order to provide the latest technology and the best care possible, we need to have a sustainable business model. In some cases, that means charging facility fees.”

Hospitals That Don’t Charge

Eight hospitals did not charge facility fees for outpatient services in 2015 or 2016, either because they did not have outpatient facilities or because they chose not to. They include, Bristol Hospital, Day Kimball Healthcare, Gaylord Hospital, Griffin Hospital, Hebrew Hospital, Natchaug Hospital, Sharon Hospital and Silver Hill Hospital.

Bristol Hospital did not charge fees in 2015 or 2016 but started charging them last year for certain services provided by its Bristol Multi-Specialty Group because they needed the money.

“We made a conscious decision going back years based on patient dissatisfaction and just our philosophy that we were going to not have patients get these fees,” said Bristol Hospital President and CEO Kurt Barwis. “When we made that decision, we were solely reacting to our community.”

“I’m not sure that it was the right choice,” Barwis added.

The decision to charge facility fees was made last summer after, Barwis said, an increase in the hospital tax caused them to end the 2016-17 fiscal year with a $3 million loss. The hospital’s tax bill increased significantly over the last few years according to state estimates. In fiscal year 2012, Bristol Hospital paid $2.94 million for the hospital tax, which increased to $7.6 million in fiscal year 2016.

Barwis said, “The initial reaction was very strong, we had quite a few patients say, ‘All of a sudden, I have to pay this additional fee?’ and obviously some of it is covered and some of it’s not covered based on the insurance carrier that they have.”

“If they are on a high deductible plan, it’s pretty significant for them,” he said.

]]>http://c-hit.org/2018/04/12/hospitals-bill-more-than-1-billion-in-facility-fees-over-two-years/feed/2Rising Rx Prices Forcing Critical Choices; States May Be Last Hope For Consumershttp://c-hit.org/2018/03/21/rising-rx-prices-forcing-critical-choices-states-may-be-last-hope-for-consumers/
http://c-hit.org/2018/03/21/rising-rx-prices-forcing-critical-choices-states-may-be-last-hope-for-consumers/#respondWed, 21 Mar 2018 13:30:29 +0000http://c-hit.org/?p=229585Thousands of consumers statewide are experiencing sticker shock at the pharmacy this year after increases in deductibles and out-of-pocket expenses for employer-sponsored insurance, forcing some to choose between their health and their finances.

Since 2003, drug costs in Connecticut have increased faster than prices across the nation, reports the nonprofit Connecticut Health Policy Project. The advocacy group also found that Connecticut residents spend more per person on prescriptions than residents in all states except Delaware and that rate is rising much faster than in other states.

According to the State Comptroller’s Office, the total net costs of prescription drugs in the state employee health plan rose 29 percent, from $257.6 million in 2014 to $332.3 million in 2017, with diabetes drugs the most expensive therapeutic class.

Some of the companies to hike prices on dozens of medications by more than 9 percent this year include Allergan Plc, Insys Therapeutics Inc., Horizon Pharma Ltd., and Teva Ltd, according to Jefferies LLC, a New York-based investment advisory firm.

“Shame does not work. Competition does not work. What’s left? Governments saying what they’re going to pay for the drug,” said Jill Zorn, a senior policy officer at the advocacy organization Universal Health Care Foundation of Connecticut. “The states are acting because the federal government isn’t.”

Connecticut and other states are stepping in to control costs. Earlier this year, the Connecticut State Healthcare Cabinet recommended, among other measures, the creation of a Drug Review Board authorized to investigate drug manufacturers’ pricing. The cabinet also called for transparency in business practices and for consumers to be charged an amount based on the negotiated price of a drug.

Maryland last year passed legislation that prohibits price gouging on essential off-patent or generic drugs. Also last year, California approved legislation requiring drug makers to provide a 60-day notice if they raise prices by more than 16 percent in two years. Nevada was first among states to pass an insulin drug pricing transparency bill.

Pharma companies are quick to note that most net price increases have been modest. “For Pfizer’s U.S. biopharma business, as of the third quarter of 2017, the weighted average net selling price increase year to date was 3 percent,” said Sally Beatty, a Pfizer Inc. spokesperson.

But Piyush Bansal, a senior analyst with Frost & Sullivan, points out that Pfizer, which maintains a large R&D facility in Groton, hiked U.S. prices for 91 drugs by an average of 20 percent in 2017. And for Big Pharma, price increases have outpaced the demand. “Maintaining profit margin was the key driver behind price increase rather than demand-supply,” Bansal said.

Legislators say they hear complaints from constituents about drug costs weekly. “Drug prices are way too high, and there are laws on the books that protect drug companies,” U.S. Senator Chris Murphy said. “I want to change those laws, to stop drug companies from overcharging and to lower costs by allowing Medicare to negotiate directly with drug companies.”

Adding to patients’ woes, pharmaceutical companies have extended patent rights on blockbuster drugs to limit competition. For example, the patent for Humira from AbbVie Pharma expired in 2014. But the company filed multiple patents surrounding Humira, from dosage tweaks to delivery methods, avoiding competition from generic products.

Insurers, too, are driving patients to ration their medication. Dr. Prasad Panthagani, an ophthalmologist in Bloomfield, said elderly patients frequently accidentally spill a few drops of glaucoma medication, such as Alphagan or Travatan, when applying it to their eyes. “If the bottle finishes before 30 days, they run out of the medicine,” he said. “Patients forego dosages for the remaining period since the insurance company won’t pay. If there is no optimal control of intra-ocular pressure, patients could lose their eyesight.” Without insurance, a 5 ml, 30-day supply of Alphagan was priced at $208; Travatan at $440.

Nora Duncan, state director at the American Association of Retired Persons (AARP), said seniors are also affected by insurers switching plan formularies in the middle of the year. “HB 7123 is a good bill on trying to limit how much can change. There is a lot of opposition from the pharmaceutical lobby; but that information should stay consistent through the calendar year.” The bill is before the legislature.

Carl Jordan Castro Photo.

Todd Gray, 54, standing in his cubicle at CPTV in Hartford. He has lived with diabetes for 20 years.

The Connecticut Health Policy Project data show that net pharmacy spending minus rebates from Connecticut’s Medicaid program tripled from 2000 to 2017. After rebates, Medicaid’s pharmacy costs decreased from $542 million in 2015 to $465 million in 2017, a drop of over 14 percent, said David Dearborn, spokesperson at the Connecticut Department of Social Services.

But for most consumers, prices cannot drop soon enough. Todd Gray’s troubles began when the deductible under his insurance plan shot up from $3,000 last year to $7,300 in 2018. Along with it, his blood sugar rose to more than 300 milligrams per deciliter as he experienced blurred vision and edginess, culminating in an “episode of yelling” at work. The 55-year-old diabetic had skipped his medication in January after sticker shock at the pharmacy.

“Walgreens said I had to pay $1,100 for one month’s supply of Humalog.” an injectable insulin, he said. “I didn’t have the money, so I didn’t buy it.” Humalog does not have a generic equivalent. A concerned colleague did some research and found Humalog online at Blink Health for $360. “I pre-pay and pick it up at Walmart,” said Gray, who also shells out $350 per month for Lantus, another diabetes drug without a generic alternative.

Part of the ire against Big Pharma is that the numbers simply don’t add up. For example, it costs just under $5 to produce a 10 ml vial of analog insulin, according to the Type 1 Diabetes Defense Fund. Eli Lilly’s launch price for Humalog in 1996 was $21, and subsequent competition from other insulin makers did not drive down the price. Instead, manufacturers began to increase prices in tandem and Humalog pharmacy price starts at $500, according to GoodRx website.

Despite the savings with Blink Health, Gray does not inject himself with Humalog three times a day as prescribed. “I do it once a day, or sometimes twice, so it can last longer.” His blood sugar is still not controlled.

“This year was tough,” he said. “Next year will be catastrophic if things don’t change.”